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NPI Code Detail

MEDICARE: MS. LAURETA SOUTH OTR/L

MEDICARE: MS. LAURETA SOUTH OTR/L
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational TherapistNY
2225XP0200XPediatric Occupational Therapist016661NY

General Provider Information

NPI Number : 1467742197
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. LAURETA SOUTH OTR/L
Provider Business Mailing Address
First Line : 150 50TH AVE
Second Line : APT 3806
City : LONG ISLAND CITY
State : NY
Zip : 11101-6050
Country : US
Telephone Number : 917-945-0060
Fax Number :
Provider Business Practice Location Address
First Line : 150 50TH AVE
Second Line : APT 3806
City : LONG ISLAND CITY
State : NY
Zip : 11101-6050
Country : US
Telephone Number : 917-945-0060
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/14/2011
Last Update Date : 06/30/2020

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